The case-cohort design obtains complete covariate data only on cases and on a random sample (the subcohort) of the entire cohort. Subsequent publications described the use of stratification and weight calibration to increase efficiency of estimates of Cox model log relative hazards, and there has been some work estimating pure risk. Yet there are few examples of these options in the medical literature, and we could not find programs currently online to analyze these various options. We therefore present a unified approach and R software to facilitate such analyses. We used influence functions adapted to the various design and analysis options together with variance calculations that take the two-phase sampling into account. This work clarifies when the widely used "robust" variance estimate of Barlow is appropriate. The corresponding R software, CaseCohortCoxSurvival, facilitates analysis with and without stratification and/or weight calibration, for subcohort sampling with or without replacement. We also allow for phase-two data to be missing at random for stratified designs. We provide inference not only for log relative hazards in the Cox model, but also for cumulative baseline hazards and covariate-specific pure risks. We hope these calculations and software will promote wider use of more efficient and principled design and analysis options for case-cohort studies.
The Cox regression, a semi-parametric method of survival analysis, is extremely popular in biomedical applications. The proportional hazards assumption is a key requirement in the Cox model. To accommodate non-proportional hazards, we propose to parameterise the shape parameter of the baseline hazard function using the additional, separate Cox-regression term which depends on the vector of the covariates. We call this model the double-Cox model. The R programs for fitting the double-Cox model are available on Github. We formally introduce the double-Cox model with shared frailty and investigat…
In biometrics and related fields, the Cox proportional hazards model are widely used to analyze with covariate adjustment. However, when some covariates are not observed, an unbiased estimator usually cannot be obtained. Even if there are some unmeasured covariates, instrumental variable methods can be applied under some assumptions. In this paper, we propose the new instrumental variable estimator for the Cox proportional hazards model. The estimator is the similar feature as Martinez-Camblor et al., 2019, but not the same exactly; we use an idea of limited-information maximum likelihood. We …
The Cox proportional hazards model, commonly used in clinical trials, assumes proportional hazards. However, it does not hold when, for example, there is a delayed onset of the treatment effect. In such a situation, an acute change in the hazard ratio function is expected to exist. This paper considers the Cox model with change-points and derives AIC-type information criteria for detecting those change-points. The change-point model does not allow for conventional statistical asymptotics due to its irregularity, thus a formal AIC that penalizes twice the number of parameters would not be analy…
For statistical inference on regression models with a diverging number of covariates, the existing literature typically makes sparsity assumptions on the inverse of the Fisher information matrix. Such assumptions, however, are often violated under Cox proportion hazards models, leading to biased estimates with under-coverage confidence intervals. We propose a modified debiased lasso approach, which solves a series of quadratic programming problems to approximate the inverse information matrix without posing sparse matrix assumptions. We establish asymptotic results for the estimated regression…
In two harmonized efficacy studies to prevent HIV infection through multiple infusions of the monoclonal antibody VRC01, a key objective is to evaluate whether the serum concentration of VRC01, which changes cyclically over time along with the infusion schedule, is associated with the rate of HIV infection. Simulation studies are needed in the development of such survival models. In this paper, we consider simulating event time data with a continuous time-varying covariate whose values vary with time through multiple drug administration cycles, and whose effect on survival changes differently …
The penalized Cox proportional hazard model is a popular analytical approach for survival data with a large number of covariates. Such problems are especially challenging when covariates vary over follow-up time (i.e., the covariates are time-dependent). The standard R packages for fully penalized Cox models cannot currently incorporate time-dependent covariates. To address this gap, we implement a variant of gradient descent algorithm (proximal gradient descent) for fitting penalized Cox models. We apply our implementation to real and simulated data sets.
IMPORTANCE: Time-to-event outcomes are commonly used in clinical trials and biomarker discovery studies and have been primarily analyzed using Cox proportional hazards models. But it's unclear which statistical models should be recommended for feature selection tasks when time-to-event outcomes are of the primary interest. OBJECTIVE: To explore if Gaussian regression of log-transformed survival time could outperform Cox proportional hazards models in feature selection. DESIGN: In this simulation study, the true models are multivariate Cox proportional hazards models with 10 covariates. For all…
Instrumental variable (IV) methods are widely used for estimating average treatment effects in the presence of unmeasured confounders. However, the capability of existing IV procedures, and most notably the two-stage residual inclusion (2SRI) procedure recommended for use in nonlinear contexts, to account for unmeasured confounders in the Cox proportional hazard model is unclear. We show that instrumenting an endogenous treatment induces an unmeasured covariate, referred to as an individual frailty in survival analysis parlance, which if not accounted for leads to bias. We propose a new proced…
The case-cohort study design bypasses resource constraints by collecting certain expensive covariates for only a small subset of the full cohort. Weighted Cox regression is the most widely used approach for analysing case-cohort data within the Cox model, but is inefficient. Alternative approaches based on multiple imputation and nonparametric maximum likelihood suffer from incompatibility and computational issues respectively. We introduce a novel Bayesian framework for case-cohort Cox regression that avoids the aforementioned problems. Users can include auxiliary variables to help predict th…
Variable selection in high dimensional space has challenged many contemporary statistical problems from many frontiers of scientific disciplines. Recent technology advance has made it possible to collect a huge amount of covariate information such as microarray, proteomic and SNP data via bioimaging technology while observing survival information on patients in clinical studies. Thus, the same challenge applies to the survival analysis in order to understand the association between genomics information and clinical information about the survival time. In this work, we extend the sure screening…
While analysing time-to-event data, it is possible that a certain fraction of subjects will never experience the event of interest and they are said to be cured. When this feature of survival models is taken into account, the models are commonly referred to as cure models. In the presence of covariates, the conditional survival function of the population can be modelled by using cure model which depends on the probability of being uncured (incidence) and the conditional survival function of the uncured subjects (latency), and a combination of logistic regression and Cox proportional hazards (P…
Polygenic hazard score (PHS) models designed for European ancestry (EUR) individuals provide ample information regarding survival risk discrimination. Incorporating such information can improve the performance of risk discrimination in an internal small-sized non-EUR cohort. However, given that external EUR-based model and internal individual-level data come from different populations, ignoring population heterogeneity can introduce substantial bias. In this paper, we develop a Kullback-Leibler-based Cox model (CoxKL) to integrate internal individual-level time-to-event data with external risk…
Cox proportional hazards model is one of the most popular models in biomedical data analysis. There have been continuing efforts to improve the flexibility of such models for complex signal detection, for example, via additive functions. Nevertheless, the task to extend Cox additive models to accommodate high-dimensional data is nontrivial. When estimating additive functions, commonly used group sparse regularization may introduce excess smoothing shrinkage on additive functions, damaging predictive performance. Moreover, an "all-in-all-out" approach makes functional selection challenging to a…
Cox's proportional hazards model is one of the most popular statistical models to evaluate associations of exposure with a censored failure time outcome. When confounding factors are not fully observed, the exposure hazard ratio estimated using a Cox model is subject to unmeasured confounding bias. To address this, we propose a novel approach for the identification and estimation of the causal hazard ratio in the presence of unmeasured confounding factors. Our approach is based on a binary instrumental variable, and an additional no-interaction assumption in a first stage regression of the tre…
In Cox regression it is sometimes of interest to study time-varying effects (TVE) of exposures and to test the proportional hazards assumption. TVEs can be investigated with log hazard ratios modelled as a function of time. Missing data on exposures are common and multiple imputation (MI) is a popular approach to handling this, to avoid the potential bias and loss of efficiency resulting from a 'complete-case' analysis. Two MI methods have been proposed for when the substantive model is a Cox proportional hazards regression: an approximate method (White and Royston, Statist. Med. 2009;28:1982-…
Important objectives in cancer research are the prediction of a patient's risk based on molecular measurements such as gene expression data and the identification of new prognostic biomarkers (e.g. genes). In clinical practice, this is often challenging because patient cohorts are typically small and can be heterogeneous. In classical subgroup analysis, a separate prediction model is fitted using only the data of one specific cohort. However, this can lead to a loss of power when the sample size is small. Simple pooling of all cohorts, on the other hand, can lead to biased results, especially …
The ratio of the hazard functions of two populations or two strata of a single population plays an important role in time-to-event analysis. Cox regression is commonly used to estimate the hazard ratio under the assumption that it is constant in time, which is known as the proportional hazards assumption. However, this assumption is often violated in practice, and when it is violated, the parameter estimated by Cox regression is difficult to interpret. The hazard ratio can be estimated in a nonparametric manner using smoothing, but smoothing-based estimators are sensitive to the selection of t…
We develop a baseline-adjusted C-index to evaluate fitted Cox proportional hazard models. This metric is particularly useful in evaluating stratified Cox models, as well as model selection using cross validation. Our metric is able to compare all pairs of comparable individuals in strata or cross validation folds, as opposed to only pairs within the same stratum/folds. We demonstrate through simulations and real data applications that the baseline adjusted C-index is more stable and that it selects better model in high-dimensional $L^1$ penalized Cox regression.
We propose new resampling-based approaches to construct asymptotically valid time simultaneous confidence bands for cumulative hazard functions in multi-state Cox models. In particular, we exemplify the methodology in detail for the simple Cox model with time dependent covariates, where the data may be subject to independent right-censoring or left-truncation. In extensive simulations we investigate their finite sample behaviour. Finally, the methods are utilized to analyze an empirical example.
A Novel Stratified Analysis Method for Testing and Estimating Overall Treatment Effects on Time-to-Event Outcomes Using Average Hazard with Survival Weight
In this work a method to regularize Cox frailty models is proposed that accommodates time-varying covariates and time-varying coefficients and is based on the full instead of the partial likelihood. A particular advantage in this framework is that the baseline hazard can be explicitly modeled in a smooth, semi-parametric way, e.g. via P-splines. Regularization for variable selection is performed via a lasso penalty and via group lasso for categorical variables while a second penalty regularizes wiggliness of smooth estimates of time-varying coefficients and the baseline hazard. Additionally, a…
High throughput genetic sequencing arrays with thousands of measurements per sample and a great amount of related censored clinical data have increased demanding need for better measurement specific model selection. In this paper we establish strong oracle properties of nonconcave penalized methods for nonpolynomial (NP) dimensional data with censoring in the framework of Cox's proportional hazards model. A class of folded-concave penalties are employed and both LASSO and SCAD are discussed specifically. We unveil the question under which dimensionality and correlation restrictions can an orac…
Latent class analysis (LCA) is a useful tool to investigate the heterogeneity of a disease population with time-to-event data. We propose a new method based on non-parametric maximum likelihood estimator (NPMLE), which facilitates theoretically validated inference procedure for covariate effects and cumulative hazard functions. We assess the proposed method via extensive simulation studies and demonstrate improved predictive performance over standard Cox regression model. We further illustrate the practical utility of the proposed method through an application to a mild cognitive impairment (M…
We consider the Cox regression model and study the asymptotic global behavior of the Grenander-type estimator for a monotone baseline hazard function. This model is not included in the general setting of Durot (2007). However, we show that a similar central limit theorem holds for $L_p$-error of the Grenander-type estimator. We also propose a test procedure for a Weibull baseline distribution, based on the $L_p$-distance between the Grenander estimator and a parametric estimator of the baseline hazard. Simulation studies are performed to investigate the performance of this test.
The additive hazards model specifies the effect of covariates on the hazard in an additive way, in contrast to the popular Cox model, in which it is multiplicative. As non-parametric model, it offers a very flexible way of modeling time-varying covariate effects. It is most commonly estimated by ordinary least squares. In this paper we consider the case where covariates are bounded, and derive the maximum likelihood estimator under the constraint that the hazard is non-negative for all covariate values in their domain. We describe an efficient algorithm to find the maximum likelihood estimator…
The Cox regression model and its associated hazard ratio (HR) are frequently used for summarizing the effect of treatments on time to event outcomes. However, the HR's interpretation strongly depends on the assumed underlying survival model. The challenge of interpreting the HR has been the focus of a number of recent works. Besides, several alternative measures have been proposed in order to deal with these concerns. The marginal Cox regression models include an identifiable hazard ratio without individual but populational causal interpretation. In this work, we study the properties of one pa…
From an optimizer's perspective, achieving the global optimum for a general nonconvex problem is often provably NP-hard using the classical worst-case analysis. In the case of Cox's proportional hazards model, by taking its statistical model structures into account, we identify local strong convexity near the global optimum, motivated by which we propose to use two convex programs to optimize the folded-concave penalized Cox's proportional hazards regression. Theoretically, we investigate the statistical and computational tradeoffs of the proposed algorithm and establish the strong oracle prop…
Randomized clinical trials with time-to-event outcomes have traditionally used the log-rank test followed by the Cox proportional hazards (PH) model to estimate the hazard ratio between the treatment groups. These are valid under the assumption that the right-censoring mechanism is non-informative, i.e. independent of the time-to-event of interest within each treatment group. More generally, the censoring time might depend on additional covariates, and inverse probability of censoring weighting (IPCW) can be used to correct for the bias resulting from the informative censoring. IPCW requires a…
The software package $\texttt{mstate}$, in articulation with the package $\texttt{survival}$, provides not only a well-established multi-state survival analysis framework in R, but also one of the most complete, as it includes point and interval estimation of relative transition hazards, cumulative transition hazards and state occupation probabilities, both under clock-forward and clock-reset models; personalised estimates, i.e. estimates for an individual with specific covariate measurements, can also be obtained with $\texttt{mstate}$ by fitting a Cox regression model. The new R package $\te…
Variable selection problem for the nonlinear Cox regression model is considered. In survival analysis, one main objective is to identify the covariates that are associated with the risk of experiencing the event of interest. The Cox proportional hazard model is being used extensively in survival analysis in studying the relationship between survival times and covariates, where the model assumes that the covariate has a log-linear effect on the hazard function. However, this linearity assumption may not be satisfied in practice. In order to extract a representative subset of features, various v…
A prevalent feature of high-dimensional data is the dependence among covariates, and model selection is known to be challenging when covariates are highly correlated. To perform model selection for the high-dimensional Cox proportional hazards model in presence of correlated covariates with factor structure, we propose a new model, Factor-Augmented Regularized Model for Hazard Regression (FarmHazard), which builds upon latent factors that drive covariate dependence and extends Cox's model. This new model generates procedures that operate in two steps by learning factors and idiosyncratic compo…
Analysing subgroups defined by biomarkers is of increasing importance in clinical research. In some situations the biomarker is subject to misclassification error, meaning the true subgroups are identified with imperfect sensitivity and specificity. For time-to-event data, it is improper to assume the Cox proportional hazards model for the effects with respect to the true subgroups, since the survival distributions with respect to the diagnosed subgroups will not adhere to the proportional hazards assumption. This precludes the possibility of using simple adjustment procedures. Instead, we pre…
Prevalent cohort sampling is commonly used to study the natural history of a disease when the disease is rare or it usually takes a long time to observe the failure event. It is known, however, that the collected sample in this situation is not representative of the target population which in turn leads to biased sample risk sets. In addition, when survival times are subject to censoring, the censoring mechanism is informative. In this paper, I propose a pseudo-partial likelihood estimation method for estimating parameters in the Cox proportional hazards model with right-censored and biased sa…
